Legal claims defining the scope of protection. Each claim is shown in both the original legal language and a plain English translation.
1. A method for generating a health care claim via a computing system, the method comprising: providing, for a user, remote access to the computing system over a network via a user device communicably coupled to the network, wherein the computing system comprises a logic subsystem; providing, for a provider, remote access to the computing system over the network via a provider device communicably coupled to the network; and responsive to receiving a query from the user via the user device, the computing system executing machine readable instructions stored on the logic subsystem for: compiling order information in a first format by: retrieving, from a database, a list of responses comprising one or more health care providers offering one or more health care services at a provider-supplied price; filtering the list of responses based on a geographic location included in the query; calculating an out-of-pocket cost for each response within the filtered list of responses based on a health care plan of the user and the provider-supplied price; and displaying, on the user device, the order information in the first format, the order information comprising the filtered list of responses with the out-of-pocket cost for each response; receiving a payment from the user via the user device for a response selected from the filtered list of responses in a form of a prepayment wherein the payment is received prior to the user receiving a corresponding service from a provider associated with the selected response, and wherein the payment equals the out-of-pocket cost for the selected response; automatically sending a notification of the payment to the provider at the provider device; and responsive to receiving an order fulfillment notification from the provider via the provider device, wherein the order fulfillment notification indicates that the service has been provided to the user, automatically providing the payment to the provider at the provider device; automatically generating the health care claim in a second format based on the provided service, the user, the provider, and a provider network of the provider, where the second format of the health care claim is different from the first format of the order information; and automatically sending the health care claim in the second format to the user at the user device.
Healthcare billing and payment processing. This invention addresses the need for a streamlined and transparent process for users to select, prepay for, and receive healthcare services, while ensuring providers are notified and compensated efficiently. The system provides remote access to a computing system for both users and healthcare providers via their respective devices over a network. The computing system includes a logic subsystem. When a user submits a query from their device, the system retrieves a list of healthcare providers and their services with associated prices from a database. This list is filtered based on the user's specified geographic location. For each filtered response, the system calculates the user's out-of-pocket cost by considering the user's healthcare plan and the provider's price. This compiled order information, including the filtered list and calculated out-of-pocket costs, is then displayed to the user. The user can select a service and make a prepayment equal to the calculated out-of-pocket cost via their device. This prepayment is received before the service is rendered. A notification of this payment is automatically sent to the provider. Upon confirmation from the provider that the service has been delivered, the system automatically disburses the prepayment to the provider. Finally, the system automatically generates a healthcare claim in a format distinct from the initial order information, based on the service provided, user, provider, and provider network, and sends this claim to the user's device.
2. The method of claim 1 , wherein calculating the out-of-pocket cost for each response within the filtered list of responses based on the health care plan of the user and the provider-supplied price comprises determining an amount covered by the health care plan of the user and subtracting the amount from the provider-supplied price.
This invention relates to a system for determining out-of-pocket healthcare costs for a user based on their health plan and provider pricing. The method addresses the problem of users lacking transparency in healthcare costs, making it difficult to compare options. The system filters a list of healthcare service responses based on user preferences, such as location or provider type. For each filtered response, the system calculates the out-of-pocket cost by determining the amount covered by the user's health plan and subtracting that from the provider-supplied price. This provides the user with a clear, personalized cost estimate. The method ensures accurate cost calculations by leveraging the user's specific health plan details and the provider's pricing data. The system may also include additional steps, such as displaying the filtered responses with their respective out-of-pocket costs to the user, allowing for informed decision-making. The invention improves healthcare cost transparency by automating the calculation of user-specific expenses, reducing uncertainty in medical service selection.
3. The method of claim 2 , wherein the calculation of the out-of-pocket cost is further based on a deductible of the health care plan of the user.
A method for calculating out-of-pocket costs in a healthcare system addresses the challenge of providing users with accurate financial estimates for medical services. The method determines the out-of-pocket cost a user must pay for a healthcare service by analyzing the service details, the user's healthcare plan, and the provider's billing information. This calculation includes applying the user's insurance coverage rules, such as copays, coinsurance, and maximum out-of-pocket limits. The method further incorporates the user's deductible, which is the amount the user must pay before the insurance plan begins covering costs. By factoring in the deductible, the method ensures the out-of-pocket cost reflects the user's current financial responsibility under their plan. The system may also compare the calculated cost against historical or benchmark data to validate accuracy. The method improves transparency in healthcare pricing, helping users make informed decisions about their care.
4. The method of claim 1 , further comprising providing, for a health insurance administrator, remote access to the computing system over the network via an administrator device communicably coupled to the network; and wherein the computing system further executes machine readable instructions stored on the logic subsystem for automatically sending the health care claim in a third format to the health insurance administrator at the administrator device responsive to receiving the order fulfillment notification from the provider.
This invention relates to a computing system for processing healthcare claims, addressing inefficiencies in claim submission and verification between healthcare providers, insurers, and administrators. The system automates the conversion and transmission of healthcare claims between different formats, reducing manual errors and delays. The system receives a healthcare claim in a first format from a provider device, converts it to a second format compatible with a health insurance provider, and sends it to the provider. Upon receiving an order fulfillment notification from the provider, the system further converts the claim to a third format for a health insurance administrator and transmits it to an administrator device over a network. The administrator device is communicably coupled to the network, enabling remote access to the system. This automation streamlines claim processing, ensuring timely and accurate submission to all relevant parties. The system may also include a user interface for managing claim data and a database for storing claim records. The invention improves workflow efficiency by eliminating redundant manual steps and ensuring consistent data formatting across different stakeholders.
5. The method of claim 4 , wherein the second format of the health care claim sent to the user at the user device is different than the third format of the health care claim sent to the health insurance administrator at the administrator device.
This invention relates to healthcare claim processing systems that adapt the format of claim data based on the recipient. The problem addressed is the inefficiency and potential errors that arise when healthcare claims are sent in a single standardized format to all parties, such as users (patients or providers) and health insurance administrators. Different recipients require different levels of detail, terminology, and presentation, leading to confusion, misinterpretation, or unnecessary complexity. The system processes a healthcare claim and dynamically formats the claim data into at least two distinct formats. The first format is sent to the user device, such as a patient's smartphone or a provider's computer, and is optimized for readability and simplicity. This may include plain language explanations, summaries, or visual aids to help the user understand their coverage, costs, or next steps. The second format is sent to the health insurance administrator's device, such as an insurer's claims processing system, and includes detailed technical, legal, or regulatory information required for adjudication, compliance, or auditing. The formats differ in structure, terminology, and content to ensure each recipient receives the most relevant and actionable information. The system may also include additional features, such as real-time updates, secure transmission protocols, or user customization options, to further enhance the efficiency and accuracy of healthcare claim communication. By tailoring the format of healthcare claims to the recipient, the system reduces errors, improves user experience, and streamlines administrative processes.
6. The method of claim 1 , wherein the provider-supplied price is adjustable by the provider via the provider device.
A system and method for dynamic pricing in a transaction platform enables providers to adjust their offered prices in real-time. The technology addresses the problem of static pricing models that fail to adapt to market conditions, provider preferences, or real-time demand fluctuations. Providers can modify their prices through a dedicated provider device, such as a mobile app or web interface, ensuring flexibility in pricing strategies. The system may also include a transaction platform that facilitates interactions between providers and consumers, where the provider-supplied price is displayed to potential consumers. The adjustable pricing feature allows providers to respond to competitive pressures, seasonal demand, or inventory levels, optimizing revenue and customer engagement. The method ensures that price changes are reflected immediately, enabling dynamic pricing adjustments without manual intervention from platform administrators. This approach enhances market responsiveness and improves the efficiency of transactions by aligning prices with real-time conditions.
7. The method of claim 1 , wherein the first format includes the one or more health care services being represented by a health care bundle indicator, the health care bundle indicator configured to uniquely identify the one or more health care services, the provider, and a location of the provider.
This invention relates to a system for managing and representing healthcare services in a standardized format. The problem addressed is the lack of a unified way to identify and track healthcare services, providers, and their locations, leading to inefficiencies in billing, coordination, and data exchange. The method involves encoding healthcare services into a structured format that includes a healthcare bundle indicator. This indicator uniquely identifies the specific healthcare services provided, the healthcare provider delivering them, and the location where the services are rendered. The indicator ensures consistency and clarity in service representation, enabling seamless integration with electronic health records, billing systems, and other healthcare databases. The structured format allows for automated processing, reducing manual errors and improving interoperability between different healthcare systems. The system supports accurate tracking of services across multiple providers and locations, enhancing transparency and efficiency in healthcare delivery and administration.
8. The method of claim 7 , wherein the provider-supplied price is associated with the health care bundle indicator.
This invention relates to a system for managing healthcare services, specifically focusing on the pricing and bundling of healthcare services. The problem addressed is the lack of transparency and efficiency in pricing healthcare services, particularly when services are grouped into bundles. The invention provides a method to associate a provider-supplied price with a healthcare bundle indicator, ensuring that the cost of bundled services is clearly defined and linked to the bundle itself. This method helps streamline billing processes, reduce administrative overhead, and improve cost transparency for both providers and patients. The system may also include steps for generating a healthcare bundle indicator, which uniquely identifies a group of healthcare services, and associating this indicator with a provider-supplied price. This ensures that the pricing structure is directly tied to the bundle, making it easier to track and manage costs. The method may further involve validating the healthcare bundle indicator to confirm its accuracy and ensuring that the associated price is correctly applied. This approach enhances the efficiency of healthcare service delivery by standardizing pricing for bundled services and reducing discrepancies in billing. The invention is particularly useful in environments where multiple healthcare services are provided as part of a single package, such as in hospital stays, surgical procedures, or comprehensive treatment plans. By clearly linking prices to bundles, the system helps providers and payers better understand and manage costs, ultimately improving the overall healthcare delivery process.
9. The method of claim 7 , wherein the health care bundle indicator comprises a sequence of alphanumerical characters.
This invention relates to healthcare data management, specifically improving the identification and tracking of healthcare service bundles. The problem addressed is the lack of standardized, machine-readable indicators for healthcare bundles, which complicates data analysis, billing, and compliance tracking. The solution involves using a sequence of alphanumeric characters as a healthcare bundle indicator to uniquely identify and categorize groups of related healthcare services. This indicator allows for efficient data processing, ensuring accurate billing and regulatory compliance. The method includes generating, storing, and retrieving these indicators to streamline healthcare administration. The alphanumeric sequence can be structured to encode specific information about the bundle, such as service type, provider, or geographic region, enhancing interoperability across healthcare systems. This approach improves data accuracy, reduces administrative errors, and supports automated processing in healthcare information systems. The indicator may be integrated into electronic health records, billing systems, or regulatory reporting tools to facilitate seamless data exchange and analysis. By standardizing bundle identification, the invention enables better coordination among healthcare providers, payers, and regulators, ultimately improving patient care and operational efficiency.
10. The method of claim 1 , wherein compiling the order information further comprises verifying eligibility of the user for coverage by the health care plan for the one or more health care services prior to calculation of the out-of-pocket cost.
This invention relates to a method for processing health care service orders, specifically focusing on verifying user eligibility for coverage under a health care plan before calculating out-of-pocket costs. The method addresses the problem of inefficient or inaccurate cost estimation in health care systems, where users may receive incorrect financial information due to unchecked eligibility status. The system first compiles order information for one or more health care services, including details such as the user's identity, the requested services, and the applicable health care plan. Before calculating the out-of-pocket cost, the method verifies whether the user is eligible for coverage under the health care plan for the specified services. This verification step ensures that only eligible services are included in the cost calculation, preventing errors and improving transparency for the user. The method may also involve cross-referencing the user's eligibility status with plan-specific rules, such as pre-authorization requirements or coverage limitations. By integrating eligibility verification into the cost calculation process, the system enhances accuracy and reduces administrative burdens, ultimately improving the user experience in health care service ordering.
11. A method of automatically generating and sending a health care claim via a computing system, the method comprising: providing, for a health care consumer, remote access to the computing system over a network via a consumer computing device communicably coupled to the network, wherein the computing system comprises a logic subsystem, the logic subsystem storing machine readable instructions executable by the computing system; providing, for a provider, remote access to the computing system over the network via a provider computing device communicably coupled to the network; providing, for a health insurance administrator, remote access to the computing system over the network via an administrator computing device communicably coupled to the network; and executing the machine readable instructions at the computing system to: display, on the consumer computing device, a health care storefront comprising a search tool; receive a query from the health care consumer via the search tool; responsive to receiving the query from the health care consumer: retrieve, from a database, a list of responses comprising one or more health care providers, each of the one or more health care providers offering a provider bundle comprising one or more health care services at a provider-supplied price; for each response, generate a health care service bundle indicator representing the provider bundle; filter the list of responses based on a geographic location included in the query; calculate an out-of-pocket cost for each response within the filtered list of responses based on a health care plan of the health care consumer and the provider-supplied price; and display, on the consumer computing device, the filtered list of responses with the health care service bundle indicator for each response and the out-of-pocket cost for each response; receive a single order placed by the health care consumer via the consumer computing device for a response selected from the filtered list of responses, the selected response comprising a particular provider bundle to be purchased; receive, via the consumer computing device, a prepayment from the health care consumer for the single order, wherein the prepayment is received prior to the health care consumer receiving a corresponding service from the provider, wherein the provider is associated with the particular provider bundle, and wherein the prepayment equals the out-of-pocket cost for the selected response; automatically send a notification of the prepayment to the provider at the provider computing device; and responsive to receiving an order fulfillment notification from the provider via the provider computing device, wherein the order fulfillment notification indicates that the service has been provided to the health care consumer, automatically provide the prepayment to the provider at the provider computing device; automatically generate the health care claim based on the provided service, the health care consumer, the provider, and a provider network of the provider; and automatically send the health care claim to the health insurance administrator at the administrator computing device.
This invention relates to a system for automating healthcare claim generation and processing. The system enables a healthcare consumer to remotely access a computing system via a network using a consumer device. The system also provides remote access to healthcare providers and insurance administrators through their respective devices. The computing system includes a logic subsystem that executes machine-readable instructions to facilitate the process. The consumer can search for healthcare services through a storefront interface, which retrieves a list of providers offering bundled services at specified prices. The system filters results based on geographic location, calculates out-of-pocket costs based on the consumer's insurance plan, and displays the filtered list with service bundle indicators and cost estimates. The consumer can place a single order for a selected service bundle, prepay the out-of-pocket cost, and receive a notification confirming the prepayment. Upon service completion, the provider sends an order fulfillment notification, triggering the system to transfer the prepayment and automatically generate and submit a healthcare claim to the insurance administrator. This streamlines the claim process by integrating service selection, payment, and claim submission into a unified system.
12. The method of claim 11 , wherein executing the machine readable instructions at the computing system further comprises, responsive to receiving the order fulfillment notification from the provider via the provider computing device, automatically sending the health care claim to the health care consumer at the consumer computing device in a first format different than a second format of the health care claim sent to the health insurance administrator at the administrator computing device.
This invention relates to a system for managing healthcare claims and order fulfillment notifications. The system addresses the challenge of efficiently processing and distributing healthcare claims between providers, consumers, and insurance administrators, ensuring that each party receives the relevant information in an appropriate format. The method involves a computing system that receives an order fulfillment notification from a healthcare provider via a provider computing device. Upon receiving this notification, the system automatically sends the healthcare claim to the healthcare consumer at their computing device in a first format. This format differs from a second format used when the same healthcare claim is sent to the health insurance administrator at their computing device. The system ensures that the claim is transmitted in a format tailored to the recipient, improving clarity and usability for both the consumer and the administrator. The method may also include additional steps such as generating the healthcare claim, receiving a healthcare order from the consumer, and processing the order fulfillment notification to trigger the claim distribution. The system facilitates seamless communication between all parties involved in the healthcare claim process, reducing administrative burdens and improving accuracy.
13. A computing system for generating and sending a health care claim, the computing system comprising: one or more databases; a network, wherein the network communicably couples a consumer computing device, a provider computing device, and a plan administrator computing device to the computing system; a processor; and memory storing processor-executable instructions that cause the processor to: responsive to receiving a query from the consumer computing device: retrieve, from the one or more databases, a list of responses comprising one or more health care providers offering one or more health care services at a provider-supplied price, the provider-supplied price being supplied as a fee schedule in any one of a plurality of fee schedule formats; for each response in the list of responses, automatically process the fee schedule to extract the provider-supplied price; filter the list of responses based on a geographic location included in the query; calculate an out-of-pocket cost for each response within the filtered list of responses based on a consumer health care plan and the provider-supplied price; and display, on the consumer computing device, the filtered list of responses with the out-of-pocket cost for each response; receive an order from the consumer computing device for a response selected from the filtered list of responses, wherein the selected response is associated with a service; receive a prepayment from the consumer computing device for the order, wherein the prepayment is received prior to the service being provided and wherein the prepayment equals the out-of-pocket cost for the selected response; place the prepayment into escrow; automatically send a notification of the prepayment to the provider computing device; and responsive to receiving an order fulfillment notification from the provider computing device, wherein the order fulfillment notification indicates that the service has been provided, automatically transfer the prepayment from escrow to the provider computing device; automatically generate the health care claim based on the provided service, consumer information from the consumer computing device, and provider information from the provider computing device; automatically send the health care claim to the plan administrator computing device; and automatically send receipt documentation based on the health care claim to the consumer computing device, a format of the receipt documentation being different from a format of the health care claim.
A computing system facilitates healthcare claim generation and processing by connecting consumers, providers, and plan administrators. The system addresses inefficiencies in healthcare service selection, pricing transparency, and claim submission by providing a centralized platform. It includes databases, a network linking consumer, provider, and plan administrator devices, and a processor executing instructions to manage the process. When a consumer queries the system, it retrieves a list of healthcare providers offering services with provider-supplied prices in various fee schedule formats. The system processes these schedules to extract prices, filters results by geographic location, and calculates out-of-pocket costs based on the consumer's healthcare plan. The filtered list, including out-of-pocket costs, is displayed to the consumer. Upon selecting a service, the consumer prepays the out-of-pocket cost, which is placed in escrow. The system notifies the provider and, upon service completion, transfers the prepayment and generates a healthcare claim. The claim is sent to the plan administrator, and receipt documentation in a different format is provided to the consumer. This streamlines service selection, payment, and claim processing while ensuring transparency and automation.
14. The computing system of claim 13 , wherein the memory stores further processor-executable instructions that cause the processor to verify a consumer account.
A computing system is designed to enhance security and authentication processes, particularly for consumer accounts. The system includes a processor and memory storing instructions that, when executed, perform account verification. The verification process involves analyzing biometric data, such as facial recognition or fingerprint scans, to confirm the identity of a user attempting to access a consumer account. This biometric verification ensures that only authorized individuals can access sensitive account information or perform transactions. The system may also integrate with existing authentication frameworks, such as multi-factor authentication, to provide an additional layer of security. By leveraging biometric data, the system reduces reliance on traditional password-based authentication, which is vulnerable to breaches and phishing attacks. The verification process is designed to be seamless, minimizing user friction while maintaining high security standards. The system may also include error handling mechanisms to address failed verification attempts, such as prompting alternative authentication methods or alerting account administrators. This approach enhances security for consumer accounts while improving user experience.
15. The computing system of claim 14 , wherein verifying the consumer account comprises submitting an eligibility verification request to the plan administrator computing device.
A computing system is designed to manage and verify consumer accounts for benefit plans, such as health insurance or retirement plans. The system addresses the challenge of ensuring accurate and secure verification of consumer eligibility for benefits, which is critical for preventing fraud and ensuring proper access to services. The system includes a consumer computing device, a plan administrator computing device, and a verification module. The verification module is configured to receive a request to verify a consumer account and then submit an eligibility verification request to the plan administrator computing device. The plan administrator computing device processes this request and determines whether the consumer is eligible for the benefits associated with the plan. The system may also include a data storage module to store verification results and a communication module to transmit verification status updates to the consumer computing device. The verification process ensures that only authorized consumers can access benefits, reducing administrative errors and fraudulent claims. The system may further include authentication mechanisms to secure the verification process, such as multi-factor authentication or biometric verification. The overall goal is to streamline the verification process while maintaining high security and accuracy.
16. The computing system of claim 13 , wherein the memory stores further processor-executable instructions that cause the processor to generate a consumer account.
A computing system is designed to manage consumer accounts and associated data. The system includes a processor and memory storing instructions that, when executed, enable the creation and management of consumer accounts. These accounts are linked to unique identifiers, such as usernames or email addresses, and may include additional user-specific data like preferences, transaction history, or authentication credentials. The system ensures secure storage and retrieval of this information, allowing consumers to access their accounts while maintaining data integrity and privacy. The system may also support account verification processes, such as multi-factor authentication, to enhance security. By centralizing consumer account management, the system simplifies user interactions with services, reduces redundancy, and improves data consistency across platforms. The system may further integrate with external databases or APIs to synchronize account information with other systems, ensuring seamless user experiences. This approach addresses challenges in managing fragmented user data, improving efficiency and security in digital account management.
17. The computing system of claim 13 , wherein the memory stores further processor-executable instructions that cause the processor to link the consumer health care plan to a consumer account.
A computing system is designed to manage consumer healthcare plans by linking them to consumer accounts. The system includes a processor and memory storing instructions that, when executed, enable the processor to receive a healthcare plan from a healthcare provider and store it in a database. The system also processes consumer account data, which may include personal information, insurance details, or medical history. The system further links the healthcare plan to the consumer account, ensuring that the plan is associated with the correct individual. This linkage allows for streamlined access to healthcare services, automated claims processing, and personalized healthcare management. The system may also verify the validity of the healthcare plan and update the consumer account with relevant plan details, such as coverage limits, deductibles, and provider networks. By integrating healthcare plans with consumer accounts, the system improves efficiency in healthcare administration, reduces errors in claims processing, and enhances the consumer experience by providing centralized access to healthcare information.
18. The computing system of claim 13 , wherein the memory stores further processor-executable instructions that cause the processor to display, on the consumer computing device, a health care storefront.
A computing system provides a platform for managing and accessing healthcare services and products. The system includes a processor and memory storing instructions that, when executed, enable a consumer computing device to interact with a healthcare provider computing device. The system facilitates secure communication between the devices, allowing consumers to access healthcare services, such as scheduling appointments, receiving medical advice, or ordering medications. The system also supports data exchange, including medical records and test results, ensuring secure transmission and storage. Additionally, the system may display a healthcare storefront on the consumer device, allowing users to browse and purchase healthcare-related products, such as medications, medical supplies, or wellness items. The storefront integrates with the system's communication and data management features, providing a unified platform for healthcare needs. The system enhances accessibility and convenience for consumers while maintaining security and privacy for sensitive medical information.
19. The computing system of claim 18 , wherein the health care storefront comprises a search tool.
A computing system provides a platform for healthcare services, enabling users to access and manage medical information, appointments, and provider interactions. The system includes a healthcare storefront that serves as an interface for users to browse and select healthcare services, providers, or products. This storefront includes a search tool that allows users to query the available healthcare offerings, filtering results based on criteria such as location, specialty, availability, or user preferences. The search tool enhances usability by providing relevant and organized results, helping users efficiently find and select the healthcare services they need. The system may also include features for scheduling appointments, accessing medical records, or communicating with healthcare providers, all integrated within the storefront to streamline the user experience. The search tool may further incorporate advanced search algorithms or machine learning to improve result accuracy and personalization over time. This system addresses the need for a centralized, user-friendly platform that simplifies healthcare service discovery and management.
20. The computing system of claim 19 , wherein the search tool receives the query from the consumer computing device.
A computing system is designed to facilitate efficient data retrieval in a distributed network environment. The system addresses the challenge of optimizing search operations by dynamically adjusting query processing based on network conditions, device capabilities, and user preferences. The system includes a search tool that processes queries from consumer devices, such as smartphones or tablets, and distributes the query to multiple data sources or servers. The search tool analyzes network latency, bandwidth, and device performance metrics to determine the most efficient query routing strategy. It may prioritize certain data sources or modify query parameters to reduce response time and improve accuracy. The system also supports real-time adjustments, allowing the search tool to adapt to changing network conditions or user behavior. Additionally, the system may include a feedback mechanism to refine query processing over time, ensuring continuous improvement in search performance. The overall goal is to enhance the speed, reliability, and relevance of search results in dynamic computing environments.
Unknown
July 7, 2020
Browse 5M+ US patents with plain-English claim translations and AI-generated analysis.